Provider Demographics
NPI:1942226964
Name:CANTOR, ADAM HARRIS (DC)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:HARRIS
Last Name:CANTOR
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:754 SIR FRANCIS DRAKE BLVD STE 2
Mailing Address - Street 2:
Mailing Address - City:SAN ANSELMO
Mailing Address - State:CA
Mailing Address - Zip Code:94960-1933
Mailing Address - Country:US
Mailing Address - Phone:415-454-9600
Mailing Address - Fax:415-454-3509
Practice Address - Street 1:754 SIR FRANCIS DRAKE BLVD STE 2
Practice Address - Street 2:
Practice Address - City:SAN ANSELMO
Practice Address - State:CA
Practice Address - Zip Code:94960-1933
Practice Address - Country:US
Practice Address - Phone:415-454-9600
Practice Address - Fax:415-454-3509
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC0028460111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADB467ZOtherMEDICARE PTAN
CADC0284600OtherMEDICARE PTAN
CADC0284601OtherMEDICARE PTAN
CADC0284601OtherMEDICARE PTAN